The National Region

Federal Democratic Business income Tax Declaration Government of Oromia

Republic of Ethiopia Schedule (with Annex)
Ethiopia Revenues Check status: Bareau of Revenue
&custom Authority Schedule C Business income tax
Mining income Tax
Section 1-Taxpayer information
1.Taxpayer’s Name Hunde & Chaltu Micro- 3.Taxpayer Identification 8.For the Year of Page1___of ____
Number June 30/2015:
Interprice
2a.Region Oromia 2b.Zone/K-Ketema\K/ TaxAccount Number Document Number(Official use Only)
Woleggaa
2c.Woreda 2d.Kebele/Farmers 2e.House 5.Tax Center Henache
Anfillo Association Number
6.Telephone Number 7. Fax Number

Section2-Tax Declaration
Income and Cost of Goods Sold//
1 Business income or sales/turnover(Transfer from Annex 1) 5
2 Non Operating and other income 10 895,674.63
3 Total Gross income(Add lines 1 and 2 and Enter Total at Right) 15 895,674.63
4 Cost of Goods Sold/Direct cost of Service(TransferTotal fromAnnex 2 ) 20 462,753.10.00
5 Gross profit/Lost(Line 3minus Line 4) 25 432,921.53
Business Expenses
6 Selling and Distribution Expenses (Transfer from Annex 4) 30
7 Salary and Wages 35
8 Other employee Benefits 40
9 Repair and Maintenance Expenses 45
1 Investment/Participation Expenses 50
0
1 Foreign Technical Service Expenses 55
1
1 Utilities Expenses 60
2
1 Travel Expenses 65
3
1 Rent Expenses 70
4
1 Interest Expenses 75
5
1 Depreciation Expenses 80
6
1 Amortization Expenses 85
7
1 Deductible Taxes and Licenses Fees 90
8
1 Deductible Donations and Gifts 95
9
2 Other Deductions(Transfer Total from Annex 5) 100 410,760.00
0
2 Total Expenses(Add Lines 6 through20 and enter total ) 105 410,760.00
1
Calculation of Tax Due
2 Net income/Loss(Line 5 minus 21) 110 22,161.53
2
2 Loss carry forward from Previous Period(From Annex 6) 115
3
2 Carry backward Loss Adjustment(Attach Supporting Document)(see instructions) 120 *******************
4
2 Taxable Business income(Line 22 minus(Line 23+24) 125
5
2 Income Tax Payable(Line 25xSchedule C Tax Rate) 130 1,614.23
6
2 Foreign Tax Credit (Transfer Total from Annex 7) 135
7
2 Withholding Tax(Attach Schedule import and Payments) 140 17,913.48
8
2 Total credits(Line 27 Plus Line 28) 145
9
 3 Net Tax Due/ Refundable Amount (Subtract Line 26from Line 29) 150 (16,299.25)
0
Section3-Attachments
- Balance Sheet - Selling & Distribution Expenses
- Profit & Loss Statement -Provisions & Reserves
- Source & Application of Fund -Gross Profit & the Manner in which it is computed
- Fixed Asset & Depreciation Schedule -Statement Of Goods Manufactured and/or cost of
- General & Administrative Expenses Goods Sold

Business Income Tax Annex

Taxpayer Information
1. Taxpayer’s Name(Company or Individual) 3.Taxpayer Identification Number 3. Statement as
2. Name Name Hunde & Chaltu Micro-
Interprice
3. TaxAccount Number

Section4-Annexes For Business Income Tax

Annex1-Business Income or Sales/Turnover
a. Seq c. Type of Income c. Amount
Num
1 Local Sates
2 Export Sales
3 Service Income
4 Tota/ (Add Line 1 through 3- Enter Total Amount On Line 1 of Tax Declaration (From 1301)
Annex2- Cost Of Goods Sold
a. Seq b. Type of Cost c. Amount
Num
1 Beginning Inventory
2 Purchases 462,753.10.00
3 Cost of Finished Goods/Direct Cost of Services(From Line 17 of Annex 3 below)
4 Goods Available for Sale(Add Lines 1,2 & 3)
5 Ending Inventory
6 Cost of Goods Sold (Line 4 minus Line 5-Enter Total Amount on Line 4 of Tax Declaration (Form 1301)) 462,753.10
Annex3-Cost of Finished Goods/Direct Cost Of Services
a. Seq b. Type of Cost c. Amount
Num
1 Beginning Work in Process
2 Cost of Direct Materials
3 Cost of Direct labor
4 Cost of Indirect Materials
5 Cost of Indirect Labor
6 Power
7 Depreciation Expenses
8 Other Supplies (Fuel, Chemicals, etc)
9 Employee Benefits
10 Repair &Maintenance
11 Insurance
12 Airfare, Transportation & Freight
13 Accommodation & Hotel Expenses
14 Excise Tax
15 Other Expenses
16 Total Over Head Costs (Add Lines 4 through 13)
17 Total cost of Manufacturing/Processed Product (Add Lines 1,2,3,& 14)
18 Ending Work In Process
19 Total Cost Of Finished Goods/Direct Cost of Services (Line 15 Minus Line 16- Enter Total Amount On Line 3 of
Annex 2 Above)
Annex4- Selling &Distribution Expenses
a. Seq b. Type of Expense c. Amount
Num
1 Salaries, Wages and Related Benefits
2 Repairs and Maintenance
3 Fuel and Lubricants
4 Travel. Accommodation & Transport
5 Advertisement
6 Commission
7 Insurance
8 Clearing, Transit & other Related Expenses 410,760.00
9 Other Expenses
10 Total (Add Line 1 through 9- Enter Total amount on line 6 of the tax Declaration (From 1301)) 410,760.00

1.Taxpayer’s Name(Company or Individual) 3.Taxpayer Identification Number 3. Statement as

Name Hunde & Chaltu Micro- Interprice
TaxAccount Number

a.Seq b. Account Description c. Amount

Num

Total (Enter Total Amount On Line 20 of Tax Declaration (From1301))

Taxpayer Information
Annex5-Other Deductions
Annex6-Loss Carry Forward from Previous Tax Period
(validity of Loss for Schedule C Normal is 3 Years; for schedule C Mining it is 10 Years )
a.Year b. Profit/Loss c. Loss App- d. Loss Carry- e. Remarks
Amount lied Forward

Transfer Total of column d to Line 23 of Tax Declaration, from 1301

Annex7-Foreign Tax Credit
a.Seq b. Name of Foreign Country c. Foreign in- d. Amount of e.Remarks
Num come Foreign Tax
Paid/Payable
 Total (Enter Total Amount on line 28 of Tax
Declaration(From 1301))
Section4- Taxpayer Certification
I declare that the above declaration and all information provided here-with is correct and complete. In understanding any misrepresentations
is punishable as per the tax law and the penal code. Declaration of prepare (other than the taxpayer) is based on all
information of which the prepare has any knowledge.
Printed Name of Taxpayer or Authorized Date
Representative For Official Use only
Signature of Taxpayer or Authorized Date of Payment
Representative
Printed Name of Prepare Date Company seal Amount of
Payment
Signature of prepare Cashiers Signature

The National Region

Federal Democratic Government of Oromia
Republic of Ethiopia
Balance sheet and
Ethiopia Revenues Annexes Bareau of Revenue
&custom Authority

Section 1-Taxpayer information

1.Taxpayer’s Name Shoki coffee supply PLC 3.Taxpayer Identification 8.For the Year of Page1___of ____
Number
2a.Region Oromia 2b.Zone/K-Ketema\K/ TaxAccount Number Document Number(Official use Only)
Woleggaa
2c.Woreda 2d.Kebele/Farmers 2e.House 5.Tax Center Ashi
Association Number
6.Telephone Number 7. Fax Number

Section2-Bussiness Assetes,Liabilityand Capital

1 Cash 10 56,188.61
2 Account receivable 20 76,598.87
3 Allowance for bed debts 30 -
4 Net Accounts Receivable 40 76,598.87
5 Pre paid expenses 50
6 Inventories 60
7 Operation supplies 70
8 Other current assets 80
9 Lonas to shareholders 90
10 Mortgage &reales estate loans receivable 100
11 Other investements 101
12 Building,cost of inprovments 120
13 Computers,soft wareproducts 130
14 Plant ,machinery,Tools&other equipment 140
15 Motor vehicles 150
16 Equipment and furniture 160
17 Add line 12through 16 165
18 Accumulated 170
depreciation
19 Net book 180
value(subtracte
 20 Intanjable assets 190
21 Acumulated Amortization 200
22 Net book value subtracte line21&20 210
23 Other assets 220
24 Total Assets 230

Liabilities
25 Account payable 240 -
26 Interste payable 250
27 Loan payable 260
28 Tax payable 270
29 Other current liabilities 280
30 Total liabilities 320

Capital
34 Capital 330 127,930.90
35 Legal reserve 340 -

Balance sheet Annex

Taxpayer Information
1. Taxpayer’s Name(Company or Shoki coffee supply PLC 2. Taxpayer Identification Number 3. Statement as of Dry coffee supply

Section5-Annexes Fixed Assets

a. Seq c. Type of Income c. Amount
Num
1 Building, cost of improvements&Reconstruction
2 Computers, softe ware and related Equipments
3 Plant machinery,Tools&Other equipment
4 Motor vehicls)
5 Office Equipment and Furniture
6 Total of line 1through 5
Annex 9 Tax payable
a. Seq b. Type of Cost c. Amount
Num
1 Employment income tax payable
2 Bussiness income tax payable
3 Rental income tax payable
4 Witholding tax payable
5 Vat Payable
6 Turn over tax payable
7 Excise tax payable
8 Dividend tax payable
9 Other tax payable
10 Total Line 28 including
2 Repairs and Maintenance
3 Fuel and Lubricants
4 Travel. Accommodation & Transport
5 Advertisement
6 Commission
7 Insurance
8 Clearing, Transit & other Related Expenses
9 Other Expenses
10 Total (Add Line 1 through 9- Enter Total amount on line 6 of the tax Declaration (From 1301))
 The National Region
Federal Democratic Business income Tax Declaration Government of Oromia
Republic of Ethiopia Schedule (with Annex)
Ethiopia Revenues Check status: Bareau of Revenue
&custom Authority Schedule C Business income tax
Mining income Tax
Tax payer certification
I declare that the above declaration and all information provided here-with is correct and complete. In understanding any misrepresentations
is punishable as per the tax law and the penal code. Declaration of prepare (other than the taxpayer) is based on all
information of which the prepare has any knowledge.
Printed Name of Taxpayer or Authorized Date
Representative For Official Use only
Signature of Taxpayer or Authorized Date of Payment
Representative
Company seal

Section 1-Taxpayer information

1.Taxpayer’s Name 3.Taxpayer Identification 8.For the Year of Page1___of ____
Number June 30/2009:
2a.Region Oromia 2b.Zone/K-Ketema\K/ TaxAccount Number Document Number(Official use Only)
Woleggaa
2c.Woreda 2d.Kebele/Farmers 2e.House 5.Tax Center Muggii
Anfillo Association mugi 02 Number
6.Telephone Number 7. Fax Number

Section2-Tax Declaration
Income and Cost of Goods Sold
1 Business income or sales/turnover(Transfer from Annex 1) 5 3,921,998.32
2 Non Operating and other income 10
3 Total Gross income(Add lines 1 and 2 and Enter Total at Right) 15 3,921,998.32
4 Cost of Goods Sold/Direct cost of Service(TransferTotal fromAnnex 2 ) 20 3,615,000.00
5 Gross profit/Lost(Line 3minus Line 4) 25 306,998.32
Business Expenses
6 Selling and Distribution Expenses (Transfer from Annex 4) 30
7 Salary and Wages 35 60,240.00
8 Other employee Benefits 40
9 Repair and Maintenance Expenses 45
10 Investment/Participation Expenses 50
11 Foreign Technical Service Expenses 55
12 Utilities Expenses 60
13 Travel Expenses 65 120,480.00
14 Rent Expenses 70 56,475.00
15 Interest Expenses 75 210,409.00
16 Depreciation Expenses 80
17 Amortization Expenses 85
18 Deductible Taxes and Licenses Fees 90
19 Deductible Donations and Gifts 95
20 Other Deductions(Transfer Total from Annex 5) 100 49,655.06
21 Total Expenses(Add Lines 6 through20 and enter total ) 105 497,259.06
Calculation of Tax Due
22 Net income/Loss(Line 5 minus 21) 110 (190,260.74)
23 Loss carry forward from Previous Period(From Annex 6) 115
24 Carry backward Loss Adjustment(Attach Supporting Document)(see instructions) 120 *******************
25 Taxable Business income(Line 22 minus(Line 23+24) 125
26 Income Tax Payable(Line 25xSchedule C Tax Rate) 130 -
27 Foreign Tax Credit (Transfer Total from Annex 7) 135
28 Withholding Tax(Attach Schedule import and Payments) 140 78,439.97
29 Total credits(Line 27 Plus Line 28) 145
30 Net Tax Due/ Refundable Amount (Subtract Line 26from Line 29) 150 (78,439.97)
Section3-Attachments
 - Balance Sheet - Selling & Distribution Expenses
- Profit & Loss Statement -Provisions & Reserves
- Source & Application of Fund -Gross Profit & the Manner in which it is computed
- Fixed Asset & Depreciation Schedule -Statement Of Goods Manufactured and/or cost of
- General & Administrative Expenses Goods Sold

Business Income Tax Annex

Taxpayer Information
4. Taxpayer’s Name(Company or Individual) 3.Taxpayer Identification Number 3. Statement as
5. Name Name ATO Mikael Teferi
6. TaxAccount Number

Section4-Annexes For Business Income Tax

Annex1-Business Income or Sales/Turnover
a. Seq c. Type of Income c. Amount
Num
1 Local Sates
2 Export Sales
3 Service Income
4 Tota/ (Add Line 1 through 3- Enter Total Amount On Line 1 of Tax Declaration (From 1301)
Annex2- Cost Of Goods Sold
a. Seq b. Type of Cost c. Amount
Num
1 Beginning Inventory
2 Purchases 3,615,000.00
3 Cost of Finished Goods/Direct Cost of Services(From Line 17 of Annex 3 below)
4 Goods Available for Sale(Add Lines 1,2 & 3)
5 Ending Inventory
6 Cost of Goods Sold (Line 4 minus Line 5-Enter Total Amount on Line 4 of Tax Declaration (Form 1301))
3,615.000.00
Annex3-Cost of Finished Goods/Direct Cost Of Services
a. Seq b. Type of Cost c. Amount
Num
1 Beginning Work in Process
2 Cost of Direct Materials
3 Cost of Direct labor
4 Cost of Indirect Materials
5 Cost of Indirect Labor
6 Power
7 Depreciation Expenses
8 Other Supplies (Fuel, Chemicals, etc)
9 Employee Benefits
10 Repair &Maintenance
11 Insurance
12 Airfare, Transportation & Freight
13 Accommodation & Hotel Expenses
14 Excise Tax
15 Other Expenses
16 Total Over Head Costs (Add Lines 4 through 13)
17 Total cost of Manufacturing/Processed Product (Add Lines 1,2,3,& 14)
18 Ending Work In Process
19 Total Cost Of Finished Goods/Direct Cost of Services (Line 15 Minus Line 16- Enter Total Amount On Line 3 of
Annex 2 Above)
Annex4- Selling &Distribution Expenses
a. Seq b. Type of Expense c. Amount
Num
1 Salaries, Wages and Related Benefits 60,240.00
2 Repairs and Maintenance
3 Fuel and Lubricants
4 Travel. Accommodation & Transport 120,480.00
5 Advertisement
6 Commission 22,551.49
7 Insurance
8 Clearing, Transit & other Related Expenses 56,475.00
9 Other Expenses 237,512.57
10 Total (Add Line 1 through 9- Enter Total amount on line 6 of the tax Declaration (From 1301)) 497,259.06

1.Taxpayer’s Name(Company or Individual) 3.Taxpayer Identification Number 3. Statement as

Name ATO Mikael Teferi
TaxAccount Number

a.Seq b. Account Description c. Amount

Num

Total (Enter Total Amount On Line 20 of Tax Declaration (From1301))

Taxpayer Information
Annex5-Other Deductions
Annex6-Loss Carry Forward from Previous Tax Period
(validity of Loss for Schedule C Normal is 3 Years; for schedule C Mining it is 10 Years )
a.Year b. Profit/Loss c. Loss App- d. Loss Carry- e. Remarks
Amount lied Forward

Transfer Total of column d to Line 23 of Tax Declaration, from 1301

Annex7-Foreign Tax Credit
a.Seq b. Name of Foreign Country c. Foreign in- d. Amount of e.Remarks
Num come Foreign Tax
Paid/Payable
 Total (Enter Total Amount on line 28 of Tax
Declaration(From 1301))
Section4- Taxpayer Certification
I declare that the above declaration and all information provided here-with is correct and complete. In understanding any misrepresentations
is punishable as per the tax law and the penal code. Declaration of prepare (other than the taxpayer) is based on all
information of which the prepare has any knowledge.
Printed Name of Taxpayer or Authorized Date
Representative For Official Use only
Signature of Taxpayer or Authorized Date of Payment
Representative
Printed Name of Prepare Date Company seal Amount of
Payment
Signature of prepare Cashiers Signature